Rich get richer / poor get poorer

[Texas Proud]

When you first said this, I thought you were joking.  You honestly believe this or perhaps I misunderstand you?

I did some research (because I couldn't believe Clinton, Bush or anyone else would create a system where everyone had the same plan).  I believe there were a number of choices of plan.  For reference: http://www.studyworld.com/The_Clinton_Health_Plan.htm.

If I did misunderstand you, my apologies.

From your article...

The Clinton plan also will limit what types of operations are covered, and it puts restrictions on how long a person can stay in a hospital, nursing home, or rehabilitation center. It would also regulate the wages of specialists, and the prices of drugs. ....

Overall Clinton's plan is generally good. If it works it will provide universal coverage with controlled costs. If it works. The problem with Clinton's plan, and in fact any other plan is that it has to put limits on operations, research, and tests. Who is to set these limits that might decide whether a person might live or die?

Clinton's plan also does not allow much for freedom of choice of doctors. Clinton is pushing the HMO (Health Maintenance Organization) part of his plan, and if one wants to choose his own doctor, he must pay a deductible and 20% of the costs of the visit.

Americans, in general, do not want an HMO type system rather they want to be able to go to the doctor they choose. American people prefer a trusting doctor-patient relationship, if they know their doctor it makes life much easier.

So, nope, you did not misunderstand me... and your post supports what I said.

 

[lets-retire]

From your article...

The Clinton plan also will limit what types of operations are covered, and it puts restrictions on how long a person can stay in a hospital, nursing home, or rehabilitation center. It would also regulate the wages of specialists, and the prices of drugs. ....

Overall Clinton's plan is generally good. If it works it will provide universal coverage with controlled costs. If it works. The problem with Clinton's plan, and in fact any other plan is that it has to put limits on operations, research, and tests. Who is to set these limits that might decide whether a person might live or die?

Clinton's plan also does not allow much for freedom of choice of doctors. Clinton is pushing the HMO (Health Maintenance Organization) part of his plan, and if one wants to choose his own doctor, he must pay a deductible and 20% of the costs of the visit.

Americans, in general, do not want an HMO type system rather they want to be able to go to the doctor they choose. American people prefer a trusting doctor-patient relationship, if they know their doctor it makes life much easier.

So, nope, you did not misunderstand me... and your post supports what I said.

Not to mention the doctor, who's wage just got cut or frozen will most likely not be willing to put in the 50+ hour weeks. Face it many people are doctors because the pay is so good.

I read limits on operations, research and tests, and I hear long wait for medical care. Limiting how long someone can be in a facility to receive care is also a decrease in service. What happens when the person does not get well enough fast enough? Do we throw them out on the street and say fend for yourself?

 

[Martha]

From your article...

The Clinton plan also will limit what types of operations are covered, and it puts restrictions on how long a person can stay in a hospital, nursing home, or rehabilitation center. It would also regulate the wages of specialists, and the prices of drugs. ....

  Limiting how long someone can be in a facility to receive care is also a decrease in service.  What happens when the person does not get well enough fast enough?  Do we throw them out on the street and say fend for yourself?

Boy, gone for a couple of days and you guys are still talking about this stuff. 

Insurance companies already limit how long they will pay for hospital stays.  Remember the brouhaha about day surgery mastectomies?   Have your breast removed and be home in time for supper.   Of course they don't throw you out if you are too sick and of course they wouldn't have done so on the Clinton plan.  Either way, a doctor is going to have to beg someone for approval.

 

[Zathras]

Texas, when you said it would force everyone to take the same service, I thought this quote "Each health alliance will have three or four different options (HMO, fee for service, and combination plans) which the consumers could choose from. " gave a different conclusion.

I just misunderstood that when you said "the same 'service'" you really meant something like 'services with limitations' which, as Martha mentioned, we already have.

 

[Texas Proud]

Texas, when you said it would force everyone to take the same service, I thought this quote "Each health alliance will have three or four different options (HMO, fee for service, and combination plans) which the consumers could choose from. " gave a different conclusion.

I just misunderstood that when you said "the same 'service'" you really meant something like 'services with limitations' which, as Martha mentioned, we already have.

Nope.. sorry.. then you did misunderstand... but the service that we were going to receive would gravitate to the average.. now, I do not know when I get good service or not... but my sister does.. and yes, the current system is 'broken'.. but the proposed fix is worse IMO....

One of the things that would get some change... if WE had to pay more for what we did.. AND we could comparison shop... now, whould that not be a hoot

 

[Texas Proud]

Boy, gone for a couple of days and you guys are still talking about this stuff.

WHAT.. you should know us better than that

And just like most discussions like this.... no minds are changed one iota.. just a good way to vent your opinions.. but I have to admit that there are some very good people on this board that have different views than me... and I respect their view..

 

[razztazz]

The Clinton plan was crap because it did not address the problem. It had some grudging intimations in that direction but what it was really all about was a massive Big Government power grab disguised as "universal access to health care".

 

[lets-retire]

Either way, a doctor is going to have to beg someone for approval.

Yup, but after arguing with the government for many, many years I'd rather argue with something in the private sector. My experience is the private company's argument will typically be something like, "it's our policy," to which I can reply I don't give a crap about your policy, and let the fun begin. The government's argument is normal, "Federal law blah, blah, requires" It is kind of hard for the little guy to argue against federal law without a lawyer.

Whether it's federal or private insurance paying the bills, the only way limiting the amount of time in a care facility will save money is by shortening the stay. If the private companies have already shortened the length of time to a minimum, then the only way the federal government can shorten it any further is to send people home, who still need in patient care. If they put verbiage in the program allowing the doctors to keep someone in the hospital as long as they feel it is necessary, with approval of course, then we are back where we started. I can see the government paying for or requiring a second opinion as to why the patient needs to be in the hospital longer than the mandated time limit. Which will also result in higher costs. I know about short stays, my wife was in the hospital for a total of three days for brain surgery. It didn't really matter much because with the meds she was on, all she did was sleep and eat a little for about a week after she came home.

Razztazz--I think we actually agree on something.

 

[Nords]

I know about short stays, my wife was in the hospital for a total of three days for brain surgery.  It didn't really matter much because with the meds she was on, all she did was sleep and eat a little for about a week after she came home.

It's tough to balance the need for emergency response with the very real risk of hospital staph infections.  I wonder if shorter stays cut down on hospitals making patients sicker without raising mortality rates...

 

[lets-retire]

It kind of makes sense, the last thing you want someone with a big gaping wound to do is hang around a bunch of sick people.

 

[greg]

One thing that really bothers me about the new Republicans is the selfishness that I see.  They send our young troops to die in the Middle East and then lower taxes for themselves (and the poor too, I guess), rationalizing the entire process.  This means that when these troops come home someday they will have to pay for the war too, pay off the national debt that building at such a fast rate.  I guess the new Republicans don't see this double duty.  Maybe their all caught up in a rapture of power--without the responsibility that should come with it.

 

[Nords]

One thing that really bothers me about the new Republicans is the selfishness that I see.  They send our young troops to die in the Middle East and then lower taxes for themselves (and the poor too, I guess), rationalizing the entire process.  This means that when these troops come home someday they will have to pay for the war too, pay off the national debt that building at such a fast rate.  I guess the new Republicans don't see this double duty.  Maybe their all caught up in a rapture of power--without the responsibility that should come with it.

Perhaps it's worse than that.

Military pay in a combat zone is tax-free. In fact Congress just revised the IRA rules to allow veterans to make full IRA contributions regardless of their W-2 numbers because many of them didn't have enough "earned income" to make an IRA contribution. There's also a little-known military combat-zone savings program that guarantees a 10% return on up to a $10K one-year investment. Of course you have to survive the entire year.

I've seen innovative manipulations of the re-enlistment system to profit from these arcane rules. An enlisted nuclear technician can commit to another 4-6 years and receive $30K (perhaps more today, I've been out of the loop for over four years). If that re-enlistment is done within the combat zone then that bonus money is also tax-free. Although the policies have probably tightened up, some people used to take temporary duty in those places for the express purpose of re-enlisting.

It's a great deal... if you're one of the survivors.

However I would much rather have Congress lowering taxes and running deficits on lower revenue than to give them the majority of my money and have them running deficits on higher revenue. They can't abuse my tax dollars if they don't get them in the first place.

 

[Texas Proud]

One thing that really bothers me about the new Republicans is the selfishness that I see.  They send our young troops to die in the Middle East and then lower taxes for themselves (and the poor too, I guess), rationalizing the entire process.  This means that when these troops come home someday they will have to pay for the war too, pay off the national debt that building at such a fast rate.  I guess the new Republicans don't see this double duty.  Maybe their all caught up in a rapture of power--without the responsibility that should come with it.

Hmmm... like the Dems did any different when they were in power... they spent money on all thier 'stuff'.. and make laws that drove costs up.. (don't get me wrong.. I think many are needed...)..

the only time the system seems to 'work' is when it can not work... that is a Republican congress and Dem president... that combination has proven to be the best for the country no matter who is in which seat..

 

[sgeeeee]

One thing that really bothers me about the new Republicans is the selfishness that I see.  They send our young troops to die in the Middle East and then lower taxes for themselves (and the poor too, I guess), rationalizing the entire process.  This means that when these troops come home someday they will have to pay for the war too, pay off the national debt that building at such a fast rate.  I guess the new Republicans don't see this double duty.  Maybe their all caught up in a rapture of power--without the responsibility that should come with it.

I'm pretty sure it's Clinton's fault.

 

[ash]

now knowing i would be reprobate to think otherwise, i would nonetheless like to know 1) the $ amount per year we, as a society, should be spending on provision of medical care, and 2) how that sum will be funded. thank you.

1) Who can say? Isn't that like asking "How much should society be spending on food." or "How much should society be spending on recreation." That's up to the market (millions of individuals acting freely in their own self-interest) and the invisible hand to conclude.

2) If politicians are to abide by the constitution (which they don't) then the federal government can't fund healthcare without an amendment. Knowing that the constitution however is largely symbolic in this day and age, and not treated as a legal contract any longer, that argument will not be welcomed. So, I would offer that those who demand services should pay for those services, because a third party payer system will result in vastly increased demand, and a reluctance to provide services (lower supply), and certainly increase the overall expenditures. It would seem that the free market would be best able to allocate the scarce resources of healthcare to best guarantee low prices and availability of services to those who need them.

If people had to pay the real cost of going to the doctor everytime, they wouldn't go in for every little sniffle and scuff, thus lowering demand.

Furthermore, if licensing requirements were lessened, there would be a higher availability of healthcare providers, decreasing the price. Do we really need someone to attend 7 years of schooling followed by a 3 years residency to be able to prescribe amoxicillin for a sore throat? And why does the government allow the AMA to restrict the number of doctors admitted to med school, essentially limiting the number of doctors? I know there are all sorts of rationalizations to this, such as "safety" and "quality." But under scrutiny, those arguments are show to be nothing more that union-style protections for medical practitioners, and have little to do with ensuring the safety of the general public.

 

[Eagle43]

One thing that really bothers me about the new Republicans is the selfishness that I see.  They send our young troops to die in the Middle East and then lower taxes for themselves (and the poor too, I guess), rationalizing the entire process.  This means that when these troops come home someday they will have to pay for the war too, pay off the national debt that building at such a fast rate.  I guess the new Republicans don't see this double duty.  Maybe their all caught up in a rapture of power--without the responsibility that should come with it.

So, let's just cut out all taxes on military personnel, past and present.  I'd go for that! 

 

[Rich_by_the_Bay]

Furthermore, if licensing requirements were lessened, there would be a higher availability of healthcare providers, decreasing the price. Do we really need someone to attend 7 years of schooling followed by a 3 years residency to be able to prescribe amoxicillin for a sore throat? And why does the government allow the AMA to restrict the number of doctors admitted to med school, essentially limiting the number of doctors? I know there are all sorts of rationalizations to this, such as "safety" and "quality." But under scrutiny, those arguments are show to be nothing more that union-style protections for medical practitioners, and have little to do with ensuring the safety of the general public.

I don't disagree with some of your points. I do disagree with some of your assertions:

The AMA has no power, discretion or any other means for restricting the number of doctors, nor their specialties. I (and probably 50% of doctors) do not even belong to the AMA. It is a shell of its former self of 50 years ago in terms of political clout, etc. It is not a union by any definition.

Where on earth did you get that information? Reminds me of an early thread where the poster was certain that doctors got paid by the prescription. I often wonder where these myths arise.

 

[ash]

I don't disagree with some of your points. I do disagree with some of your assertions:

The AMA has no power, discretion or any other means for restricting the number of doctors, nor their specialties. I (and probably 50% of doctors) do not even belong to the AMA. It is a shell of its former self of 50 years ago in terms of political clout, etc. It is not a union by any definition.

Where on earth did you get that information? Reminds me of an early thread where the poster was certain that doctors got paid by the prescription. I often wonder where these myths arise.

Rich,

I was speaking to the fact that licensing laws, by their very nature, restrict the number of doctors that can practice medicine.

To the extent of which trade organizations are actively engaged with the government to define policy (school accreditation, admissions, regulations, etc.), I have commonly heard that the AMA is one of the key players. If there are others or more powerful organizations, I'm simply not familiar with them.

My intent was certainly not to smear the AMA, I'm sure they are doing what they are supposed to be doing, looking out for the interests of physicians.

My point however is that licensing in and of itself has increased costs, by limiting the number of providers, while not providing the increase in quality that was promised. Milton Friedman can say it better than I can: "I am myself persuaded that licensure has reduced both the quantity and quality of medical practice. . . . It has forced the public to pay more for less satisfactory medical service."

http://www.cato.org/pubs/pas/pa-246.html (The Medical Monopoly: Protecting Consumers Or Limiting Competition? by Sue A. Blevins)

So I guess then, I would ask you to help educate me. Who controls the accreditation and admissions processess? Obviously the government enforces them, but surely some trade organization works closely with the colleges and with the government to define restrictions. I have heard repeatedly that the organization is the AMA, but if I'm wrong, please explain it more accurately to me. Thanks.

 

[Rich_by_the_Bay]

So I guess then, I would ask you to help educate me. Who controls the accreditation and admissions processess? Obviously the government enforces them, but surely some trade organization works closely with the colleges and with the government to define restrictions. I have heard repeatedly that the organization is the AMA, but if I'm wrong, please explain it more accurately to me. Thanks.

Accreditation is by a separate private Association of American Medical Colleges, or a similar independent group, IIRC. They review curricula, lab facilities, clinical supervision and other things most would consider reasonable to assure decent training. You must graduate from an accredited medical school to apply for a license.

States are responsible for licensure, and this is basically a vetting process. There are national exams (3 of them at least) that every applicant must pass and they are not trivial.

The number of places available is up to the medical school. In the case of public supported ones the state legislature decides based on need and budget. Private schools decide based on resources, physical plant, etc.

To my knowledge, the AMA is out of these loops. Zero. Nada.

The health care delivery system is filled with problems, but I don't think this aspect of things is a big one. Hope that helps.

 

[ladelfina]

ash, you crack me up..! I guess if you don't like the fact that doctors are licensed you can always go to Mexico for Laetrile, coffee enemas, and $5 liposuction.  

Hairdressers and barbers have to be licensed! Does that mean there's no free market for haircuts?

I guess licensing can increase costs, but lack of licensing would increase them far more.. think of the number of potential malpractice claims.. brrr.. then the highly-limited number of non-free-market licensed lawyers will really be able to write their own ticket!  

(Thanks Rich, for your supremely measured response.. you're a better man than I.)

 

[Rich_by_the_Bay]

ash, you crack me up..! (Thanks Rich, for your supremely measured response.. you're a better man than I.)

No sh&%! Talk about over the edge, reckless reactionary bull.

There, I feel better.

BTW I really enjoy your posts. Always insightful, great sense of humor, and I like the way you think.

 

[razztazz]

Accreditation is by a separate private Association of American Medical Colleges, or a similar independent group, IIRC. They review curricula, lab facilities, clinical supervision and other things most would consider reasonable to assure decent training. You must graduate from an accredited medical school to apply for a license.

States are responsible for licensure, and this is basically a vetting process. There are national exams (3 of them at least) that every applicant must pass and they are not trivial.

The number of places available is up to the medical school. In the case of public supported ones the state legislature decides based on need and budget. Private schools decide based on resources, physical plant, etc.

To my knowledge, the AMA is out of these loops. Zero. Nada.

I hate to sound like I'm agreeing with ash and I don't want to pick a fight with The Doctor. BUT... Medical schools & state legislatures establishing "body" quotas, states establishing licensing specifics etc. Accreditation by Association of American Medical Colleges, none of these things means that the "Professional Class" isn't pulling the strings or having their input "duly considered" (rubber stamped) just because the AMA by name is officially not on the party list. I think it's Doctors involved in some way at every step doing what Adam Smith told us they'd do.

 

[ash]

Wow, I didn't think that pointing out that licensure laws restrict supply and therefore increase costs was such a controversial concept, since that is the very thing they are designed to do!

Whether or not that is a good or bad thing by leading to better or worse service can certainly be debated, but it DOES lead to higher costs as long as there are sufficient candidates being turned away from medical school.

I apologize for "recklessly" bringing the AMA into something, that apparently is run by someone called the AMC. Whatever acronym happens to be deciding that, my point was that someone is in fact deciding it and restricting the supply.

 

[ash]

ash, you crack me up..! I guess if you don't like the fact that doctors are licensed you can always go to Mexico for Laetrile, coffee enemas, and $5 liposuction.

Hairdressers and barbers have to be licensed! Does that mean there's no free market for haircuts?

I guess licensing can increase costs, but lack of licensing would increase them far more.. think of the number of potential malpractice claims.. brrr.. then the highly-limited number of non-free-market licensed lawyers will really be able to write their own ticket!

(Thanks Rich, for your supremely measured response.. you're a better man than I.)

Weird. All I said was that if "licesning laws were lessened..." and you jump to $5 liposuctions. My example even was measured in that possibly someone with less than 10 years schooling/residency should be able to prescribe amoxicillin. Why the extreme reply?

 

[sgeeeee]

I hate to sound like I'm agreeing with ash and I don't want to pick a fight with The Doctor. BUT...  Medical schools &  state legislatures establishing "body" quotas, states establishing licensing specifics etc. Accreditation by  Association of American Medical Colleges, none of these things means that the "Professional Class" isn't pulling the strings or having their input "duly considered" (rubber stamped) just because the AMA by name is  officially not on the party list. I think it's Doctors involved in some  way at every step doing what Adam Smith told us they'd do.

I had the same thoughts. The "medical establishment" by whatever formal or informal organizational structure does a lot of harm related to supply of medical doctors and regulation of who can administer medicine. Many doctors tend to become very defensive about these issues when you bring them up. I'm pretty sure this all Hillary's fault.